西地那非联合高频振荡通气治疗新生儿肺动脉高压的安全性及疗效的对比性研究

Safety and curative effect of sildenafil combined with high- frequency oscillatory ventilation in treatment of neonatal pulmonary artery hypertension: a comparative study

目的探讨西地那非联合高频振荡通气（HFOV）治疗新生儿肺动脉高压（PPHN）的安全性及效果。方法收集中~重度均需使用HFOV的足月PPHN患儿88例分为西地那非联合HFOV治疗组48例和HFOV对照组40例,主要研究其安全性：能否降低PPHN患儿的死亡率、是否增加低血压的发生率、是否增加肺动脉压力（PAP）反弹的发生率;次要研究其疗效：氧合指数（OI）、动脉血氧分压（Pa O_2）、血氧饱和度（Sa O_2）、肺动脉压力（PAP）、呼吸机平均气道压（MAP）、吸入氧浓度（Fi O_2）、机械通气时间、用氧时间、住院时间等的变化。结果西地那非组死亡率2.1%,对照组死亡率15.0%,两组差异有统计学意义（P〈0.05）。西地那非组低血压发生率2.1%,对照组发生率17.5%,两组差异有统计学意义（P〈0.05）。西地那非组PAP反弹率4.2%,对照组7.5%,两组差异无统计学意义（P〉0.05）。西地那非组与对照组治疗后OI、Pa O_2、Sa O_2、MAP、Fi O_2、PAP、机械通气时间、用氧时间、住院时间差异均有统计学意义（P〈0.05）。结论西地那非联合HFOV治疗足月儿的PPHN是安全有效的。

Objective To explore the safety and curative effect of sildenafil combined with high- frequency oscillatory ventilation（ HFOV） in treatment of neonatal pulmonary artery hypertension. Methods Eighty- eight full- term neonates with moderate to severe pulmonary artery hypertension treated by HFOV were divided into combined treatment group（ 48 neonates treated by sildenafil combined with HFOV） and control group（ 40 neonates treated by HFOV）. The main research content was the safety： reducing the mortality rate of neonates,increasing the incidence rate of hypotension,increasing the incidence rate of pulmonary artery pressure（ PAP）. The secondary content of research was the curative effect： changes of oxygenation index（ OI）,arterial partial pressure of oxygen（ Pa O2）,degree of blood oxygen saturation（ Sa O2）,PAP,mean airway pressure（ MAP）,fraction of inspired oxygen（ Fi O2）,time of mechanical ventilation,time of oxygen therapy,and hospitalization time. Results The mortality rates in combined treatment group and control group were 2. 1% and15. 0%,respectively,there was statistically significant difference between the two groups（ P〈0. 05）. The incidence rates of hypotension in combined treatment group and control group were 2. 1% and 17. 5%,respectively,there was statistically significant difference between the two groups（ P〈0. 05）. The rebound rates of PAP in combined treatment group and control group were 4. 2% and 7. 5%,respectively,there was no statistically significant difference between the two groups（ P〈0. 05）. There were statistically significant differences in OI,Pa O2,Sa O2,MAP,Fi O2,PAP,time of mechanical ventilation,time of oxygen therapy,and hospitalization time after treatment between the two groups（ P〈0. 05）. Conclusion Sildenafil combined with HFOV in treatment of full- term neonates with pulmonary artery hypertension is safe and effective.